I was delighted to see a recent article in a psychology journal that offers scientific evidence that being nice to ourselves is a more skillful way of dealing with our screw-ups than being hard on ourselves. Most of us fear that if we take the pressure off ourselves, we will screw up even worse. Not so, says this article. In fact, it is self-criticism actually increases the likelihood that you’ll screw up even more. Hard to believe? Read on.

Being kind to oneself doesn’t come easily to most people. We tend to be much better at caring for others. History reveals evidence of humans and other species showing kindness toward one another. Our primate relatives groom one another and care for their young. Fossil evidence has shown that at least a million years ago, early humans cared for others with severe physical deformities. Those social behaviors seem rooted in our brain physiology. It’s obvious from both psychology and physiology, that we’re intrinsically compassionate beings. (Gilbert)

Why then the disconnect when it comes to being compassionate toward ourselves? While we might have no trouble telling a friend who’s messed up not to beat themselves up about it, we have a surprisingly hard time turning that advice toward ourselves. We are often harder on ourselves than we are on others. Some people who grew up in supportive homes with understanding parents are more likely to be kind to themselves, but the majority of us are not very compassionate toward ourselves. Self-compassion is something that actually needs to be taught to most people, especially people who tend to be self-critical, anxious or depressed. (Neff)

The reverse is also true, i.e., the kinder a person is to him/herself, the higher the sense of emotional well-being they have. For example, in a study of women who were HIV positive, it was found that the women with a high degree of compassion for themselves tended to practice safe sex and disclose their HIV status to sexual partners more frequently than the women who showed little compassion for themselves. The benefits of our being compassionate toward ourselves carry over into our self-care and regard for others. (Leary)

People who are compassionate to themselves are also more likely to seek medical care if they need it. The more self-critical a person is, the more unlikely they are to seek care. In one study of elderly people, those with health problems and a healthy sense of self compassion reported similar levels of happiness and emotional well-being as those of elderly people who had NO health problems. The researcher suggested: “It’s like self-compassion erases the emotional fallout of some of the problems associated with aging.” (Leary)

In a study related to eating behavior, female college students were asked to eat doughnuts in what was described as a taste-test experiment. One group of the women were “conditioned for self-compassion” by statements from the test administrators such as “Everyone eats unhealthily sometimes, and everyone in this study eats this stuff, so there’s no reason to feel bad about it.” Another group of women were not “conditioned” with these statements. After the doughnut test, all the women were asked to participate in a taste test of various candies. The group of women who were “conditioned for self-compassion” ate less candy than the women who were not “conditioned for self-compassion”. Previous studies have shown that people who are recurrent dieters do tend to overeat unhealthy foods after a “slip.” One suggested explanation is that dieters are already feeling guilty about the first slip, and that they engage in more ‘emotional eating’ to deal with the pain of the guilt. This study suggests that self-compassion may limit the distress that leads to later emotional eating binges. (Leary)

Overweight individuals aren’t the only ones with something to gain from a kinder-to-self approach. A growing body of research suggests that self-compassion offers the same positive benefits of self-esteem — without the negatives. (The negatives to self-esteem can be seen in people who appear arrogant and in people whose self-esteem is dependent upon approval or success.) Self-compassion is a way to develop healthy self-esteem that does not have the negative aspects that the more tenuous kinds of self-esteem can have. Another benefit of self-compassion vs. self-esteem is that all too often a high sense of self-esteem encourages attempts to weed out all the negatives about oneself in order to become perfect. Self-compassion is based more on a sense of wholeness, acknowledging that all of us are human and so susceptible to human error and imperfection. (Neff)

Definition of Self-Compassion

One researcher posits that self-compassion has three main components. One is to be understanding [toward yourself] rather than self-judgmental. “Most people’s internal dialogue is actually quite harsh,” she says. “The self-kindness part requires reframing your dialogue so that you’re kind and supportive [toward yourself].” (Neff)

The second component involves framing your personal experience as a typical human experience. When something goes awry — your car breaks down on the highway, say, or you get passed over for a promotion at work — a common emotional reaction is “Why me?” The sense that things aren’t going the way they should can lead to a sense of isolation, which often leads to depression and anxiety. The opposite of that reaction is recognizing that all humans experience frustration, disappointment and rejection at some point. You can let the suffering that being human entails comfort you in your own suffering. And you can then let the compassion you feel for yourself spread out to all human beings who suffer in the same way you do. Then, rather than feeling isolated in your suffering, you can actually use compassion to help you feel connected to others. (Neff)

The third element of self-compassion involves awareness. On one hand, you must be aware of self-criticism in order to curtail it. But mindfulness also requires that you see things as they truly are, instead of exaggerating a situation or adopting a “poor-me” attitude. A clear perspective is crucial because it will help you understand the difference between healthy self-compassion and unhealthy self-pity. (Neff)

Research

Self-compassion is a very old Buddhist idea which has only recently begun to be looked at from a research perspective. Kristin Neff, PhD, a professor of Human Development and Culture at the University of Texas at Austin, is one of the researchers exploring the area. After defining self-compassion from an academic perspective, she developed a scale to measure it and many researchers have used that scale in subsequent studies. By far most of the findings support the idea that self-compassion is linked to a number of positive mental health outcomes, including increased happiness, optimism and social connectedness. People who score high on self-compassion also tend to suffer less from anxiety, depression, rumination and fear of failure.

Dr. Neff has also developed a training program to teach people to practice self-compassion. She suggests starting on paper. For example, say you’re upset that you made a big mistake at work. What would your most supportive friend say about the experience? Write down everything this friend might say to you, from his or her point of view. Then read the letter back to yourself — and try to take the words to heart. To get more exercises for increasing self-compassion, you can go to You Tube and search under Kristin Neff. She has a variety of training videos available.

Although there is more research that needs to be done, it seems clear that cultivating self-kindness is well worth the effort. As Paul Gilbert, Ph.D., another researcher says, “If you have a kind, encouraging, supporting part to you, you’ll be OK. If you have a bully that kicks you every time you fall over, then you’re going to struggle.”

More Good News – There’s No Bad News

What are the downsides of self-compassion? None have been found so far — and not for lack of trying. Initially another researcher, Mark Leary, Ph.D. suspected as I did that self-compassion might be linked to self-indulgence. If you’re too nice to yourself, he theorized, you can let yourself off the hook no matter what you’ve done wrong. To his surprise, he found just the opposite. People high in self-compassion take more responsibility for the bad things that happen to them than those who do not have high self compassion. One reason low-compassion people might deny responsibility for bad things is that they have a mistaken sense of responsibility – they expect too much of themselves and then feel horribly bad if they’re not perfect. People high in self-compassion, however, can admit their mistakes without all that self-flagellation.

Perhaps an amendment to the Golden Rule might be “Treat yourself as kindly as you would want others to treat you.”

***

Information in the above article was taken from the Monitor of Psychology, published by the American Psychological Association, Vol. 42, No. 7, July 2011, p. 42. Science Watch: “Golden Rule Redux” by Kristen Weir.

It’s becoming increasingly well known and accepted that thoughts, feelings, and physical experiences are interrelated and deeply inform and impact one’s daily life. For example, a single thought (“I’m running late”) almost instantaneously causes a feeling (such as fear or worry) which triggers a physiological response such as rapid pulse rate and sweaty palms. A holistic perspective—holding head, heart, and body as equal and interconnected aspects of the human experience—can also add to a deeper discovery and understanding of one’s personality drive.

The teachings of the Enneagram (please refer to the first and second articles on the Enneagram for more information) include distinctions between what are called the “Triads” or “Centers”: Feeling (heart), Thinking (head), Instinctual (gut/physical). The personality drives fall into each of these as follows:

Heart/Feeling Triad:

2 (Helper/Be Loved)

3 (Achiever/Performer)

4 (Individualist/Be Special)

Head/Thinking Triad:

5 (Thinker/Researcher)

6 (Loyal Skeptic/ Safety/Security)

7 (Enthusiast/Adventurer)

Gut/Instinctual Triad

8 (Challenger/Self-Reliant)

9 (Peacemaker)

1 (Reformer/Be Right)

The three personality drives in each triad/center have a shared “root” emotion/issue that each drive responds to and defends against either by over expression (2s, 5s, 8s), under expression (4s, 7s, 1s), or denied existence (3s, 6s, 9s).

For the Feeling triad (2s, 3s, and 4s): their power lies in ability to feel emotions (2 feel too much of only positive emotions, 4 feel too little positive emotion, and 3s deny their authentic emotions all together). The root issue of the Feeling triad is shame and hostility:

Root: SHAME and HOSTILITY

2s deny hostility and act as an idealized person to compensate for the shame

3s deny shame and then try to fill the gap by being what they achieve

4s try to fix the shame by shoving hostility down deep never finding it

For the Thinking and Doing triad (5s, 6s, and 7s): their power lies in ability to think and take action (5s think too much and therefore act too little, 7s act too much and think too little, and 6s deny their thoughts and actions value all together). The root issue of the Thinking and Doing triad is anxiety and dread:

Root: ANXIETY and DREAD

5s dread/are afraid of the world and overwhelmed by people, go inside their heads to knowledge/thoughts (source of all power to 5s) so can be free of the anxiety and dread.

6s don’t trust their own thinking and doing, so they look outside themselves to the world to handle the anxiety and dread for them so they won’t have to deal with it, to make safe from the anxiety/dread

7s run away from the anxiety/dread to lose self in the excitement and adventure of the world

For the Instinctual/Physical triad (8s, 9s, and 1s): their power lies in ability to instinctually, from the gut, take impulsive action (8s are overcome with aggressive “animal” instinct to quickly and blindingly, 1s repress their animal instinct, and 9s deny their gut’s very existence). The root issue of the Instinctual triad is aggression and resentment:

Root: AGRESSION and RESENTMENT

8s express aggression and say “deal with it”

9s deny aggression and resentment not wanting to rock the boat

1s sublimate aggression into idealism and perfection. Try to make aggression sublime (not just repressing it, shoving it down and having it come up as righteousness and doing the right thing)

Knowing your personality drive’s place within the triads can be very helpful in discovering not only the root issue that needs healing, but also where the key to your power lies for optimal personal growth.

Resources

There are many resources on the Enneagram, but the ones I work with most are from Riso & Hudson’s Enneagram Institute (www.enneagraminstitute.com) and The Wisdom of the Enneagram, Daniels & Price’s The Essential Enneagram, and Concept Synergy’s Harnessing Your Personality Drive Through Exploring the Enneagram as well as PPV Enneagram: Forging the New Self.

Happiness is your nature. It is not wrong to desire it.
What is wrong is seeking it outside when it is inside.
– Sri Ramana Maharshi

When children grow up with experiences of trauma or deprivation, it is not uncommon for them to feel an inner emptiness. Confronted with what may be overwhelming negative emotions (sadness, hurt, fear, unworthiness,) and never having had the opportunity to learn healthy “self-soothing,” these individuals adapt by finding or developing more unhealthy coping strategies, including various form of addiction. They learn to search, reach and cling outside themselves to anything that seems to offer some immediate release from their pain.

The word “addiction” comes from the Latin addictus (pp of addictio), meaning an awarding, giving over, devoting or surrendering to. In addiction, we give over to the object of our addiction our power and ability to know we are okay, enough, whole. We actually, unknowingly, surrender our identity.

That being said, it can be argued that we are all addicted in some way. We all have things we can, consciously or not, cling to in order to tell ourselves we are okay in a given moment. We can be addicted to substances (drugs, alcohol, food,) activities (work, shopping, gambling, sex, exercise,) relationships and persons, receiving praise or attention, controlling others, and even to beliefs about ourselves and other internal thought processes (denial, interpreting situations as saying/confirming something negative/shameful about us – as unworthy or stupid.) Yes, we can be addicted to negative thoughts and feelings about ourselves, even addicted to an identity as an addict – as a way of experiencing a known, predictable, solid identity and not having to confront the fear, confusion, groundlessness of not knowing, and the responsibility that comes with accepting our choicefulness.

All addictions arise from the same place within us and all share a common effect. All addictions are (conscious or unconscious) reactive attempts to temporarily reduce, eliminate, or avoid facing and moving through our pain. The result, however, is that they all block in us our ability to open to receiving that which we are, at heart, truly seeking: knowing that we are enough and loved for who we are in any given moment; that we are already whole just as we are.

Well-known spiritual teacher Ram Dass describes the experience addictive behaviors afford as a “short rush” allowing us a “taste of heaven” and “home” but not allowing us to remain because we didn’t get there in a right, real way. There is a yearning to come home, but we continually find ourselves thrown out by the negative self-thoughts and feelings we were trying to avoid in the first place, now seemingly reinforced by our ‘bad’ behavior. In our attempt to fill the whole, we feel it only growing. [For Ram Dass’ full commentary on Attachment and Addiction, go to http://www.youtube.com/watch?v=T3ixRqOauq4.]

Healing is Making Whole

Eminent Swiss psychiatrist Carl Jung, in a letter to Alcoholics Anonymous co-founder Bill Wilson, described the alcoholic’s craving for alcohol as “the equivalent . . . of the spiritual thirst of our being for wholeness.” Continued attempts to satisfy the thirst through addictive behaviors, however, render it ultimately unquenchable. As a common AA saying goes, “For an alcoholic, one drink is too many and a thousand is never enough.” In other writings, Jung stated that it is our darkness, our “shadow” aspects that we are compelled to disown, that have the capacity to be our greatest teachers and tools for growth. He wrote that our felt brokenness results from an alienation from who we are. We heal by embracing, not dividing. Healing is making whole.

If the addict’s perceived self is an empty or fragmented self, how does one create a sense of self based in wholeness and fullness?

My teacher, Swami Jaya Devi Bhagavati, was once asked by a student struggling to understand and reconcile the co-existence of God and war, whether God was absent in war. Swami Jaya Devi’s response was that God was present, but that the awareness of God was absent. Another twelve-step saying is that an addict is “not a bad person getting good, but a sick person getting well.” Addicts are not bad or evil people absent good, they have simply lost or lack awareness of their true goodness, leading them to wage the internal war of addiction.

Learning to practice simple awareness – without reactivity – is therefore a vitally important tool in addressing addiction. We need to learn to sit and be and allow a feeling or sensation without jumping to interpretation that something is (or I am) wrong, bad and/or needs to be changed. Awareness, itself, allows for transformation. We give power to a feeling by resisting it. We have already transformed our relationship to it and its power over us by not reacting to it. It no longer needs to be removed in order for us to be whole and okay.

Most people are familiar with the expression, “Whatever we resist, persists.” It is also and perhaps even more accurate to say that it is not so much that we resist things because they are painful, but that they are painful because we resist them. We can transform our experience of, and relationship to, pain. Simple breath meditation – sitting with our eyes closed and following our breath in and out, bringing our attention back to our breath when we become aware our mind has wandered (because it will) – is one way to begin training ourselves in awareness and focus without judgment. Anything that happens inside of us is okay – anything we think and everything we feel. Nothing we think or feel is evidence of our not being enough. And nothing we have done diminishes our wholeness.

The teachings and practices of yoga can be powerful resources on our journey to wholeness and ‘enoughness.’ Yoga literally means “union” and “wholeness of being.” It is designed to “yoke” the practitioner to her or his deepest Self. Yoga is an “eight-limbed path” toward our highest consciousness, toward true contentment and happiness. One of these limbs, pratyahara, most directly addresses addiction. Pratyahara is the withdrawal of the senses, a turning inward. When we practice pratyahara we stop chasing our external sense experiences and focus our attention inside ourselves, directing our energy internally. We practice coming back to center, to our heart. We come home in a way that allows us to stay.

The physical practices of yoga, the asanas (postures) and pranayama (breathwork), are also valuable in cultivating our experience of wholeness. To “practice yoga while you’re practicing yoga” can be a great challenge. It means to be fully present in our body and breath, neither judging nor forcing ourselves beyond what is true and right for our body in that moment. We are given the opportunity to practice awareness and acceptance and ‘enoughness’ on the mat, then bring this experience off the mat and apply it in our everyday lives.

There are also specific practices in yoga that can help move us toward wholeness. Our bodies are energy bodies, with thousands of energy paths running through it. There are seven main energy centers in our physical body, beginning at the base of our spine and moving up to the crown of our head. The second of these energy centers, or chakras, is located low in our abdomen. Correlated with the sex/reproductive organs in our body, the second chakra is also associated with creativity and the element of water. When in balance, we experience ourselves ‘in the flow.’ When out of balance, we have a tendency toward avoiding, controlling or ignoring our feelings. At its extreme, this imbalance leads to self-denial, self-rejection and self-deprivation. When we are blocked in this way, when this flow of receptivity is dammed, we are unable to connect with that which would truly satisfy us. Our ability to enjoy any activity is in direct proportion to how present and open we are to it in the moment.

The second chakra is considered the seat of duality (separation), unworthiness and of addiction. Its name, Svadisthana, means “sweetness” or “one’s own place or base.” Addicts’ external searching is a longing for the elusive sweetness of feeling/ knowing they are finally ‘home sweet home.’ Yoga practices that balance second chakra energy (e.g., Seated Spinal Flex) help bring us home.

“I Am Enough” MeditationFind a comfortable seated position, lengthen your spine and gently close your eyes. Begin taking full, satisfying breaths, focusing your attention on the sensations of your inhalation and exhalation. After several breaths, bring your focus to the second chakra, low in the abdomen just a few inches above your pubic bone. Imagine you could feel the energy of the breath coming in and out of your second chakra. Allow yourself to feel the flow of that energy. Begin a silent mantra of “I am, therefore I am enough” on each inhale, and “I am, therefore I am enough” on each exhale. Continue this breath for 3-11 minutes. When you feel ready to complete the meditation, bring your attention to the center of the chest, called our spiritual heart. Breathe in and out of your spiritual heart three times repeating, “I am, therefore I am enough.” Know that you are enough, you are home and you can stay. When you are ready, slowly begin to open your eyes.

Addiction – the experience of craving in this way and looking for the ‘quick fix’ in whatever form it takes – is a signal that we are out of balance. One of the ways to approach addiction, therefore, is to seek the experience of balance, rather than reactively seeking the quick (and actually unbalancing) fix. An important element in addressing any addiction, not just food addictions, is to balance our blood sugar. When our blood sugar is out of balance, it typically triggers the feeling of craving and a state of reactivity; the quick fix becomes very hard, if not impossible, to resist. Our ability to be choiceful and response-able is greatly compromised. The best way to balance our blood sugar is to eat three full, satisfying meals at least 3-4 hours apart, with no between-meal snacking. If you feel a strong need for sweet, sugary treat, the best time to have it is as a lunchtime dessert, when it is least likely to have as strong an impact on your blood sugar. Snacking prevents our blood sugar from stabilizing by keeping it in constant movement.

Know that it is absolutely normal to grieve the loss of your addiction; it is like losing your best and most trusted friend. Know, too, that every addict struggles with being present in their bodies, in their lives and in the world. Recovery is a process of developing awareness and acceptance of all that you are, without judgment and reactivity. With this awareness, you begin to confront the truths your addictive behaviors were ‘protecting’ you from, and in so doing you reveal to yourself the truth that you already are, and have always been, whole and enough.

We live in a stressful world. Anxiety is a part of the human condition.

Many people complain of feelings of anxiousness, ranging from occasional mild worrying to full-blown anxiety disorders such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Social Phobia, or a specific Phobia.

Although anxiety is a normal human emotion, we find feelings of anxiety unpleasant and typically try to avoid experiencing them. Attempts to avoid anxious feelings may include overeating, drinking alcohol, watching TV, taking prescription medications, or staying away from situations or people that may trigger anxiety. In their new book, “The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life,” Orsillo and Roemer propose that avoiding anxiety or attempting to control it does not ease pain and suffering. Rather, avoidance brings its own costs. The authors suggest that to break free from anxiety, instead of avoiding anxious feelings, we practice coping strategies that allow us to turn toward and pay close attention to anxiety. Turning toward something that we would usually avoid and taking a fresh look at habitual responses are crucial components of mindfulness.

Before exploring how mindfulness can help us break free from the grip of anxiety, let’s look at an example of what anxiety is.

Jody recently moved to New York City from Alabama to start a new job. Heading into a corporate meeting, she notices that most of her coworkers are already seated and chatting with one another. She takes a chair between two groups already engaged in conversation and begins shuffling through her papers. She feels her anxiety rising. Some of the thoughts that go through her mind include, “I don’t fit in here,” “My clothes are all wrong,” and “They must think I’m an idiot.” She feels her face flushing, palms sweating, and pulse quickening. Thinking of the friends she left behind at her former job, she feels a wave of sadness and regret. She despairs as she thinks about the years ahead of her, just knowing that she will always feel alone. For the duration of the meeting, she keeps her eyes downcast, contributing nothing to the discussion.

As this story illustrates, components of anxiety include thoughts, emotions, physical sensations, and behaviors. Evolutionarily, humans are hardwired to feel fear. Fear is actually a helpful warning that alerts us to potentially dangerous situations. When we perceive a threat, the fight-or-flight response kicks in to ready us to combat or escape from harm. The physical symptoms we experience when this response occurs (increased heart rate, rapid breathing, adrenaline rush, etc.) are merely side effects of the body getting ready to fight or flee.

Compared to fear, anxiety is a more subtle but chronic state. Whereas fear is an automatic response to a threat we perceive as immediate, anxiety includes thinking about or imagining some possible threat we may come up against in the future.

Orsillo and Roemer’s research indicates that our struggle with fear and anxiety does not come from any actual harm caused by the physical sensations of these emotions. Rather, it arises from our reactions to these emotions and the thoughts, sensations, and images that accompany them. Criticizing ourselves for feeling fear or anxiety is what hurts us, not the fear and anxiety themselves. This is where the turning inward is helpful. Mindfulness can help us replace self-criticism with compassion.

Simply put, mindfulness is a specific way of paying attention. It involves “purposefully expanding your attention to take in both what you are experiencing inside – your thoughts, feelings, and physical sensations – and what is happening around you.” (p. 81) The key concepts of mindfulness include 1) Noticing – becoming fully aware of the thoughts, feelings, physical sensations, and images that you experience, as well as the details of your environment; 2) Curiosity – approaching experiences with openness; and 3) Self-Compassion – acknowledging that the reactions we have are part of being human, accepting what cannot be controlled, and treating yourself with kindness and care.

The authors provide a series of exercises progressing from a 5 minute breath exercise through a number of informal and formal techniques to practice mindfulness. Readers are also encouraged to download audio recordings from the book’s website to listen to while practicing or to record their own scripts.

Shane trembled as she waited her turn to stand behind the podium and deliver her speech. She had agreed months ago to make a presentation before her colleagues at the real estate convention, even though she was terrified of public speaking. As the previous speaker was concluding his remarks, Shane felt her stomach churn. Her neck felt tight and sore, she felt the blood rushing to her face as she blushed, and she began sweating profusely. “Why, oh why did I ever agree to this?” she thought. She recalled the incident in high school when she had forgotten her lines in the school play, and now she relived those old feelings of embarrassment. “It will be just like in high school!” “These people will think I’m so stupid.” “No one will ever refer any business to me again, ever!”

Orsillo and Roemer would say that Shane is experiencing “muddy” emotions. This occurs when we bring in memories of past events – and conjecture about future possibilities – into the current moment. If Shane were to take a moment to be mindful of the immediate challenge, she would realize that she is muddying her current anxiety by worrying about “what if” rather than focusing on “what is.”

The authors write in a style that is easy to follow and offer many vignettes to provide examples. They also address the questions that many readers may be asking:

But isn’t mindfulness a Buddhist principle?Is it a new age fad? What if I have different spiritual beliefs?

The term mindfulness indeed originated with Buddhism, but the idea has recently been included in research and therapeutic settings. In fact, mindfulness practice has been shown to decrease anxiety, insomnia, stress, risk of coronary heart disease, substance use, chronic pain, and fibromyalgia, and increase attention, sexual functioning, quality of life, and immune system functioning. The book does not focus on the religious aspect of mindfulness.

How can I find the time to practice mindfulness?

While research suggests that more practice is associated with greater benefit, the authors offer a variety of techniques including exercises that only take 5 minutes a day. They also point out activities that you can do mindfully, such as eating, walking, washing dishes, folding laundry, petting your dog, cooking, listening to music, or hugging a friend.

How can mindfulness help with anxiety?

By this time you may be thinking, “Gee, thanks, but no thanks. I’m already acutely aware of my anxiety. Why on earth would I want to focus on it more?” Yes, it is seemingly counterintuitive, but mindfulness can actually help us notice what we are experiencing and make choices about how we want to respond, rather than automatically reacting in ways that hold us back from fully engaging in our lives. Let’s look at one more example that illustrates the value of mindfulness:

Sam was on a third date with Chris. He had been single for a long time and knew that he wanted to develop an intimate relationship. He was quite fond of Chris, and was getting signals that the feeling was mutual. As the talk turned more personal, he felt his pulse quicken, his chest tighten, and his mouth get dry. He felt the urge to change the subject so he wouldn’t risk feeling vulnerable and getting hurt. He watched Chris for cues, and thought he saw a frown of displeasure when Sam talked about a low point in his life. What Sam really wanted to do was excuse himself, pretend to go to the bathroom, and run like hell out the back door of the restaurant. However, he really wanted to build a connection with Chris, so he chose to remain in the situation.

Often the things that really matter to us, like loving people, forming emotional connections, taking on challenging tasks, or caring for those in pain and suffering, bring with them emotional pain. In these cases, living a fulfilling life means that we notice the pain and allow it, rather than trying to make it go away. Mindfulness can help us to embrace our entire range of emotional experiences, making it easier to make these choices and enrich our lives.

I am pleased to have found a book that I can recommend to clients, family, and friends who are dealing with depression and wanting to better understand their treatment options. While the title of the book indicates the subject matter is that of antidepressants, Dr. Banov does a thorough job of discussing various alternatives to traditional medication therapy, including psychotherapy, supplements, exercise, healthy eating, light exposure, yoga, meditation, and more. The fact that the discussion is not limited only to antidepressant medication makes this book much more worthwhile, in my opinion.

Over the years of providing therapy, I have talked with many clients about antidepressant medication. I have found that it is very, very rare that clients feel immediately open to this option. Many come around and try antidepressants and many do not. I am always amazed by what strong opinions exist about medication therapy. People feel that it is “not natural” (neither is cataracts surgery, but most don’t object to this), that they “shouldn’t need it,” or that they should somehow be able to overcome a chemical imbalance through sheer will. It is not the fact that a person has a negative reaction that bothers me – perhaps we should all be more cautious about our medical care. It is this strange phenomenon that average people suddenly seem to fancy themselves a medical expert when it comes to mental health medications. For example, when I was pregnant, I had to be on blood thinner medication. This involved giving myself injections once or twice a day for the entirety of my pregnancies. I certainly received many reactions from people who knew about this (mostly sympathy and some shock at the thought of taking shots everyday), but I never once had someone tell me that I probably didn’t need the medication, that my doctors didn’t know what they were talking about, that blood clotting disorders don’t really exist, or that I could fix my clotting issue by adjusting my attitude. People almost never question treatment or medication for heart disease, Alzheimer’s, or high blood pressure, but when it comes to mental health issues everyone is suddenly an expert. And most likely they haven’t read the first word about depression or its various treatments.

Mental health disorders and their treatment still carry an enormous stigma in our society, despite the fact that an “estimated one quarter of the population will suffer from depression at some point in their lives” (p. 10) and antidepressants are “the most commonly prescribed class of medications” (p. 7). Because of this stigma, depression is more often hidden and dealt with privately. The downside of this is that many, many people do not comprehend the realness of depression, how it differs from the regular sadness and stress we all face in life, and the serious consequences that can result.

When I think about depression, a funny story comes to mind about my sister. She was living in Oregon with some mountain biking enthusiasts who invited her to join an on-road trek one day. Although she had not done much biking, she was a lover of exercise who was in great health and very good physical condition. She figured she was up for the challenge. From almost the very beginning she had great trouble keeping up. She felt discouraged with herself, first frustrated by her poor performance and then questioning if she had been crazy to think she could do this. She felt embarrassed for others to see her struggling and felt badly for slowing them down. She began doubting everything she knew to be true of her fitness, wondering if maybe she wasn’t in great shape, if her daily runs were not really all that impressive, if she wasn’t a real athlete at all.Finally, one friend who knew she could do better took a quick look at her bike. Guess what they found? Her tires were not properly inflated. She was literally doing twice the work to get half as far. Imagine her relief to discover this – not only was she not the utter failure she was beginning to feel like, but also the rest of the day was sure to go much better. As she set out again, looking forward to the ride ahead, she found that she was still struggling to keep up. The same feelings of embarrassment, self-doubt and inadequacy followed. After more time and more struggle and more slowing down of the other bikers, someone took a second look at her bike. This time they discovered that her brakes were functioning improperly and were actually partially applied. For every push of her pedals, the brakes were working against her by trying to stop her in her tracks. Once this problem was resolved, the day went much more as she had envisioned. She was not at the head of the pack, but she was certainly capable of an afternoon ride with some friends.

I promise that this story is true, and although I am sorry that my sister had to suffer through it, I am so grateful to have this excellent analogy of how depression can feel. It is not necessarily that a person with depression can’t function, that they lay on the sofa all day crying or feeling like dying, that they don’t leave the house, feed the cat, go to work, etc. Though depression can look this way at its extremes, many people with depression can continue to function in their lives to the point that others may not even know they are suffering. It is just that the effort it takes to get through normal daily tasks can feel overwhelming. For many, depression comes on quite gradually so that they might not fully notice its presence in their lives. Like my sister on her mountain bike, they may simply think they are lazy, unmotivated, and incapable of achieving their goals. They may chastise themselves for not being able to get their lives together, get things done, or function as well as other people seem to. Not recognizing that depression plays a part can have devastating consequences. Their goals, dreams, relationships, productivity may be slipping away while all the while self-loathing and hopelessness is growing. Depression leads to a great deal of suffering, and not recognizing and getting help for depression leads to worsened depression and therefore greater suffering. It affects not only the person who has it, but their loved ones as well.

Dr. Banov points out that the “emotion of depression” must be distinguished from “the illness of depression” (p. 38). While we all have feelings of sadness or despair at times, the illness of depression (sometimes referred to as a chemical or clinical depression) is a medical condition that causes changes in the physical body and brain. Brain scans of people with depression have shown decreased activity and even atrophy in the hippocampus (plays a role in mood and memory), prefrontal cortex (responsible for planning and attention), the amygdala (generates emotional response during emotionally charged events), and the thalamus (serves as the “communication hub” between our thinking and feeling areas in the brain) (p. 76-77). Depression also can cause or exacerbate other health problems, by affecting insulin levels and blood sugar, compromising the immune system, and leading to elevated blood pressure as well as reduced muscle tissue and bone thickness (p. 79).

Dr. Banov’s book is so packed full of information, any attempt to summarize would be futile. He covers the types of depression, the brain mechanisms that are involved, the various medications used to treat depression, how these medications are believed to work, research studies that both support and do not support their use, typical side effects and how to manage them, generics versus brand names, what to do if your anti-depressant begins to lose effectiveness or causes a numbing of your emotion (not its intended effect), if antidepressants are addictive (they are not), the when and how of discontinuing an antidepressant, and how to deal with special circumstances such as drug interactions, travel, surgery, or pregnancy. Dr. Banov also covers in depth the importance of having a check up for your physical health and the many physical disorders with symptoms that can mimic depression (i.e. thyroid disorders or diabetes).

If you suspect that you or someone you care about is dealing with depression, I highly recommend this book. It contains so much useful information, it could actually be overwhelming for a person with depression to try to decipher all at once. My personal recommendation would be to read the first few chapters to determine if you might be experiencing depression and what your treatment options are. If you do decide to take antidepressant medication, I would suggest that you wait until that time to read more about side effects or long term use. Having read the book myself in just a few days, I can honestly say it is a lot to absorb. Some topics are covered in incredible detail, such as the functioning of neurotransmitters in the brain, and other topics could have used slightly more attention, such as the types of psychotherapy and how alcohol and illicit drug use can worsen depression. To his credit, I appreciate Dr. Banov providing an incredibly comprehensive look at all issues relevant to the topic of depression, even if the reader may want more information on the few areas of special interest to them.

In reading this article and possibly reading this book, I hope that the first message you will take away is that depression is real, and it is serious. It is also quite treatable. Antidepressant medication has been in use since the 1950’s and is improving every year. While most people do not like the idea of taking medication, I can tell you that the vast majority of clients I have known who have taken it have found it to be effective and quite easy to tolerate. While they might initially worry that it is not natural or will change their personality in some way, I have heard many a client say “I finally feel like myself” again once the medication kicked in.

As I stated in my introductory paragraph, one of the best things about this book is its emphasis on treatment strategies other than antidepressant medication. If you want a truly unbiased look at the pro and cons, research support and lack of support, you will find it all in this book. If you want tips on how changing your diet can help and specific foods or supplements that might alleviate depression, you will find that information. I think the best piece of wisdom in the entire book is Dr. Banov’s early recommendation to assess your “depression and antidepressant attitude” (p. 15). Take a moment to evaluate any automatic thoughts or assumptions you have about depression and its treatment. Know that this is your bias and that you are likely to be influenced by it now and in the future. Be on the lookout for when this bias starts to creep in and do your homework to get a fair and balanced perspective.

Here is my bias: I believe that Western medicine has many drawbacks, including a quick-fix mentality and too often a focus on symptoms rather than the cause. When I think about what we ask our bodies to do, given what we put into them nutritionally, I am sometimes surprised that we function at all. I know that my car runs on gasoline, and I never attempt to make it run on water, sugar, sand, or olive oil. Yet, because we can get by eating a diet of processed foods, we often do. I do not know what percentage of depression might be caused by our diets, lack of exercise, spiritual disconnect, etc., but I am guessing a certain number of people could improve their depression by focusing on these aspects of their lives. Some people, however, will also need medication plus these other things to make their lives rich and fulfilling.

I do not suggest that all of my clients consider antidepressants – not by a long shot. I have seen some clients for years before this type of discussion has ever come up. With other clients, it might be mentioned in our first session. It all depends on how much a person is suffering. In many cases, I think it makes sense to try other things first – healthier foods, sunshine, exercise, yoga, social contact, etc. But if your life feels like it is unraveling and the damage is starting to mount up, an antidepressant may very well be the best choice. There is no rule that you can’t do all those other things too. Most importantly, do something to treat your depression. You deserve to feel better.

Karuna’s Articles

Every other month, Karuna therapists publish an article here. We hope you find these articles informative and helpful. Feel free to search for topics or browse through our categories below. We welcome requests for topics as well.

Why Karuna

As counselors and clinicians, we are committed to holistic therapeutic approaches that respect and empower our clients. Our goal is to help each individual discover and develop her or his own inner resources and capacity for healing and growth.